Localised Ileocaecal Crohn’s Disease: Early Surgery Deserves a Place Beside Biologics: Colorectal Disease | September 2026 | Systematic Review & Meta-analysis
Introduction:
Biologics are commonly used early in Crohn’s disease, while surgery is often reserved for complications or treatment failure. This meta-analysis compared early ileocaecal resection with biologic-first therapy in biologic-naïve patients with localized ileocaecal Crohn’s disease.
Why was this study needed?
Surgery is traditionally viewed as a last resort in Crohn’s disease.
Modern minimally invasive resection may offer durable disease control.
Selected patients with localized disease may benefit from early surgery rather than prolonged medical therapy.
Key Findings:
The analysis included 1,644 biologic-naïve patients from one randomized trial and two cohort studies.
Early resection was associated with substantially less subsequent surgery (RR 0.09).
In two studies, 48% of surgery-first patients were medication-free at final follow-up.
In contrast, all biologic-first patients ultimately required continued medication or surgery.
The findings support discussing surgery as an early therapeutic option, particularly for localised ileocaecal disease.
Evidence certainty was low to very low.
Medical comparators were mainly infliximab and adalimumab, limiting comparison with newer IL-23 and other advanced therapies.
Bottom Line:
For selected localised ileocaecal Crohn’s disease, early resection should be discussed alongside biologic therapy—not simply after medical treatment fails. Stronger comparative evidence with modern biologics is still needed.
